IRANDERMA

A
35-year-old man presented with about two decades history for
pruritic pustular eruptions on his scalp that produced a disfiguring
alopecia. The conditions failed to respond to a variety of medications
including different antibiotics and both topical and systemic steroids.What
is your diagnosis?and what
do you recommend in managing this patient?

FD
probably is a heterogenous group of disease in which chronic folliculitis
leads to progressive scarring alopecia. The exact cause of FD is still
unclear and is proposed to be due to a local failure in the immune
response. Based on this possiblity, all patients should be investigated
for underlying immune deficiency, although in my experience almost always
this investigation is normal!

Perifolliculitis
capitis is a similar condition that should be differentiated from FD. To
compare please see the quiz of september 2004.

In
treating FD, systemic antibiotics, dapsone and retinoids reported to be
effective.

Here
are some of the experts' recommendations:

Farzaneh
Farahani, MD: treatment: if no response to any antibiotics so
Ro_accutane is choice

Sana
Mostafa, MD: dx:folliculitis decalvans,treatment is isotretinoin if
does not respond to rifampicin

M.T.
Noorbala, MD : recent case is a good sample of decalvans
folliculitis. systemic antibiotic with or whitout rifampin ,systemic
and/or topical steroied, and systemic retinoids may also be helpful.